Robotic Surgery for Esophageal Cancer

Overview

Robotic surgery for esophageal cancer is a minimally invasive surgical technique in which robotic instruments assist the surgeon in removing the complete or a portion of the esophagus (food pipe connecting your throat and stomach), depending upon the location of the cancer and affected area.

Robotic surgery is used in cancerous tumors; however, it can also be employed in certain noncancerous or benign conditions when the esophagus function is affected, leading to problems with swallowing food. Robotic surgery is preferred over conventional open or laparoscopic surgeries owing to better precision, less pain, less blood loss, quick recovery time and a similar success rate.

Alternate Name

Robotic-Assisted Esophagectomy

Body Location

Esophagus (food pipe connecting your throat and stomach)

How Performed

Robotic-assisted esophagectomy is performed under general anesthesia and you will be asleep throughout the procedure, unable to feel any pain or sensation. Your surgeon will make multiple small incisions (usually less than 1 inch) in your chest/thoracic area to insert various surgical tools, including robotic arms and a highly-magnified camera for accessing the esophagus. The site is inflated for the surgery and the surgeon uses a console to control robotic arms and a camera to create high-definition visuals on the computer screen. These visuals are 3-dimensional and aid the surgeon in examining the affected tissue precisely without disturbing the other sensitive nerves and tissues.

The surgeon will remove the complete or a portion of the esophagus along with lymph nodes with the help of robotic arms and reconnect the remaining esophagus. A nasogastric tube will be placed through the nose to keep your stomach decompressed. A jejunostomy tube (J-tube) will also be inserted from the side of your abdomen into the small intestine for nutrition. The incisions will be stitched carefully under sterile conditions.

Preparation

• Before undergoing robotic surgery for esophageal cancer, your surgeon will ensure that you are the right candidate for the surgery by assessing your medical history and current disease conditions. You will be recommended certain blood tests such as CBC (complete blood count), bleeding time, clotting time, etc.
• You will also undergo a pre-anesthesia checkup (PAC), including an electrocardiogram (ECG) and a chest X-ray, where a doctor will assess your suitability for the surgery. You might also be tested for anesthesia sensitivity.
• Your surgeon will order certain imaging tests, such as a computerized tomography (CT) scan or a positron-emitting tomography (PET) scan to identify the location of cancer and plan the procedure; however, metastasis is not reliably predicted from CT or PET scans. Additionally, the surgeon might order a biopsy to understand the type and stage of esophageal cancer.
• You should inform your doctor if you are taking any medications, especially blood thinners such as warfarin, aspirin, etc. You might be given anti-anxiety medications to calm your nerves a few days before the surgery.
• You must quit smoking, tobacco use, and alcohol use at least a few weeks before the surgery to avoid complications.
• You should not eat or drink anything post-midnight, the day before the surgery. You should reach the hospital at least 4-6 hours before the scheduled time, as you will be kept under observation for some time before preparing for the surgery.

Procedure Type

Minimally invasive surgery

Follow-up

You will be given a follow-up schedule/chart and you should ensure to report for all the follow-ups for a complication-free recovery. You will be called for follow-ups, where the surgeon will remove the J-tube and nasogastric tube once you can swallow the food. Keep the incisions clean with gentle soap and water to avoid the risk of any infection. Do not rub the incisions and dry them by patting them with a soft clean cloth. You should avoid using the bathtub or swimming pools as these could lead to infections or excessive pressure on the incisions.

You should start with light physical activity after the surgery, such as walking, and you can increase the distance slowly as you gain strength. However, you should avoid strenuous activities such as cycling, running, jogging, lifting weights, etc. Physical activity will help you recover quickly, but you should not overexert yourself and take plenty of rest and sleep. Avoid excessive bending as it will put pressure on the chest region and cause discomfort.

Risks

Although robotic surgery is more efficient and safer than traditional surgeries; however, being a major surgery, robotic-assisted esophagectomy is associated with the following risks.

• Incision site infections could occur and you might require antibiotic treatment.
• Incision site pain/ redness/ inflammation.
• Pneumonia could occur due to the involvement of the chest.
• Bleeding and blood loss can occur.
• Damage to the adjoining or nearby organs/tissues could warrant further medical intervention.
• Blood clot formation could occur and these clots could move to other body organs such as lungs, etc.
• Hypersensitivity to anesthesia is another potential side effect in sensitive individuals.

In addition, robotic surgery could be associated with the following side effects:

• Leakage at the connection site between the esophagus and stomach
• Voice hoarseness
• Difficulty swelling
• Lymphorrhea (Lymphatic fluid leakage)

Recovery

Following the surgical procedure, you will be kept under active monitoring. Then you will be shifted to the recovery room within a few hours to a few days, depending upon the complexity of the surgery. Depending upon your overall health and stability of vital parameters, you will be discharged from the hospital within a few days while the J-tube and nasogastric tubes are still attached to you. Following the removal of these tubes, your surgeon will examine for any signs of infection and inflammation to ensure a smooth recovery.

The complete recovery may take a few months and you can start returning to your routine activities. During the recovery phase, good care is required and you should not indulge in heavy work for a few months. If your job requires heavy work, discuss it with your surgeon. Regular follow-ups are critical to an event-free recovery, as your surgeon will monitor your progress. Drink plenty of fluids and eat a nutritious diet for a quick recovery. Take your medications as prescribed by your doctor and avoid self-medication. Always look for warning signs of complications such as prolonged cough, pain in the esophagus area, fever, diarrhea, and black stools, and seek immediate medical attention if required.